OPS/MCI Flashcards
EMS Roles and Responsibilities
Preparation Response Scene management Patient assessment and prehospital care Management and Disposition Patient Transfer Documentation Return to Service
EMS medical director roles
Education and training Participate in selection of personnel Participate in equipment selection Develop clinical protocols Quality improvement Provide input into care Interface among EMS systems EMS advocacy to community Medical conscience to EMS
Protocol
Treatment plan for specific illness or injury
Standing order
Type of protocol that is a written document signed by the EMS medical director that outlines specific directions, permissions, and sometimes prohibitions.
Continuous Quality Improvement
Improves systems quality by including:
ID system wide problems
Conduct in-depth review of problems
Aid the problems and develop remedies
Develop action plan for correcting problems
Enforce the plan of action
Re-examine the problem
ID excellence in pt care
Look for modifications for standing orders
ID situation not covered by protocols/standing orders
Descriptive research
Research that is basically an observation only. No attempt to change or alter an event occurs.
Experimental research
When a skill, new product, or general idea is used in a trial phase, and the effects are evaluated.
Prospective research
Research that defines a clear problem or question prior to gathering data
Cross-sectional research
Research that is based on a group of people over an outlined time frame.
Format for research projects
Intro Methods Results Discussion Conclusion
10 steps to conducting a research project
Prepare a question Write a hypothesis Decide what to measure and method to use Outline the population ID study limitations Acquire approval from ethics board Obtain consent from population used Gather data Analyze data Decide what to do with final research product.
Defence mechanisms for psychological stress
Denial
Regression
Projection
Displacement
Stages of the grieving process
Denial Anger Bargaining Depression Acceptance
Criteria for level 1 trauma centre referral: Vitals and anatomic criteria
GCS: 13 or less; SBP <90;
Penetrating Injury to head, neck, torso, proximal extremities; flail chest; 2 or more proximal long bone fx; crushed, degloved, mangled extremity; amputation proximal to wrist/ankle; pelvic fx; open/depressed skull fx; paralysis.
Criteria for trauma centre referral: MOI that does not necessarily require lvl 1 depending on examination
Falls >6m (adult), >3m (child); auto collision: >35 cm intrusion (occupants) or >55cm anywhere; ejection; death in compartment; vehicle data consistent w/ high risk;
Pedstruck >35km; motorcycle >35km.
MOI evidence of high-energy trauma: referral to Lvl 1 trauma centre
Ejection from vehicle; death in compartment; pedstruck >8km; initial speed of MVA >65 km; intrusion >35cm or 55cm deformity; extrication >20 min; fall > 6m; rollover (unrestrained passengers); motorcycle collision >35km with separation of rider and bike
Special patient or system factors for level 1 trauma referral
Age > 55; pediatric; anticoagulant and bleeding disorders; burns with trauma; time sensitive extremity injury; renal dialysis; pregnancy > 20wks; EMS judgement; cardiac or respiratory comorbidity; T1D, cirrhosis, obesity, coagulopathy.
Incident command system roles and responsibilities
Command, finance, logistics, operations, planning.
Incident commander
Person in charge of the overall incident. Duties include public information, safety, and liaison
Finance chief responsibility in MCI
Documenting all expenditures for tracking and reimbursement
Logistics responsibility in MCI
Communications equipment, facilities, food and water, fuel, lighting, and medical equipment and supplies for patients and responders.
Operations section responsibility during MCI
Supervises people working at the scene
Planning section responsibility during MCI
Obtain data about the problem, solves problems, analyzes previous incident plan
Medical incident command
Medical branch of the incident command system. Medical incident command supervises the primary roles of: triage, treatment, and transport.
Triage unit tasks
Initial assessment, tagging, and triaging of all patients. Help move patients to appropriate treatment centre. Do not begin treatment until all patients have been triaged.
Treatment unit tasks
Locate and set up treatment area with a tier for each patient. Provide treatment for patients, and help move patients to the transport area.
Transportation unit tasks in MCI
Coordinate transportation and distribution of patients to receiving hospitals.
Staging officer tasks at MCI
Establish a staging area for emergency vehicles or agencies. Coordinate plan to prevent traffic congestion and release vehicles and supplies when ordered by command.
Rehabilitation officer tasks in an MCI
Facilitate responder rest, fluids, food, and protection from the elements. Monitor responders for signs of stress or exhaustion
Primary triage
The initial triage done in the prehospital environment. Patients are briefly assessed and identified in some way such as a triage tag.
Secondary triage
Done as patients are brought to the treatment area.
Red triage tag category (priority)
Airway and breathing difficulties Uncontrolled or severe bleeding Severe medical problems Shock Severe burn Open chest or abdominal injury
Yellow tag triage priority (delayed)
Burns without airway problems
Major or multiple bone or joint injury
Back injury with or without spinal cord damage
Green tag triage priority (walking wounded)
Minor fractures
Minor soft tissue injuries
Black tag triage priorities (expectant)
Obvious death
Obviously insurvivable injury, such as open brain trauma
Respiratory arrest (if limited resources)
Cardiac arrest
START triage red (priority) category
RR greater than 30 or less than 10
Absent or weak, irregular radial pulse
Unable to follow commands
Any or all of the following are immediate (red)
START triage yellow category
RR between 10 and 30
Strong radial pulse
Follows simple commands
Unable to walk
START triage green category
Walking wounded
JumpSTART triage
Used for children younger than 8 or who appear to weigh less than 45kg.
Not breathing but has a pulse: open airway. If still apneic, give 5 breaths and assess again. If still apneic, label black.
RR less than 15 or more than 45: label red
Absent or weak, irreg distal pulse: label red
Unresponsive, postures to pn, incomprehensible sounds: label red
Localizes or withdraws from pn: label yellow
